It’s not whether “Sex Matters", but how

I stumbled on this piece by Cordelia Fine from a handful of years ago. It is characteristically brilliant and cuts through to my problem with "#SexMatters" as a rallying cry by anti trans campaigners.

It’s not that sex doesn’t matter. I think most of us agree it does. How could the material physicality of the human body in various ways not “Matter". The real question, is how does it matter?

It was extremely interesting to see in the article that Fine was responding mainly to attacks by Claire Lehmann, editor of Quillette Magazine, over "the influence of feminism" on science, when her arguments were in the first place that ignoring sex difference in one area of researched caused a leak of undisclosed sex based biases into outcomes from the research. Alert readers will be aware that Claire Lehmann and Quillette have championed similar attacks on the threat of “trans ideology" to “science", broadly coordinated around dismissing trans specific knowledge in favour of sweeping (frankly, stereotyping) generalisations about the differences between men and women.

The case example Fine discusses is research around the dosing of a drug (Ambien). Men and women were given identical doses, and women had more side effects. These were used to hypothesise that women’s "female brains" responded negatively to the drug because of the brain’s femaleness. It turned out on further investigation that because women are on average just smaller the same dose for each sex is more likely to be problematic for some women without any special brain differences (other than size).

So: while she was accused of erasing sex differences her argument was that sex differences need to be appropriately characterised and understood in order to not mistake differences for essence — small men would also have negative side effects from the drug! At a population scale this is a sexed different, but on a person to person scale the difference in effect was based on body size.

My big problem with anti trans #SexMatters as a rallying cry is that it tends to throw the diversity of our individual needs right out the window. In most cases I have seen “Sex Matters" arguments, they are fundamentally what I would call sex-reductionist. They insist trans women must be treated as men as a class, because there are overall patterns observable across all men and the realities of differences between trans women and cis men don’t matter. Even aside from the clear observable social and behavioural differences (trans women transition!) this creates numerous immediate risks of eliminating any means by which health care safe for trans people may be practiced.

For example trans women grow breasts and face health risks associated that closer to the risk patterns faced by women than men. Transgender men undergoing testosterone therapy on the other hand, face a more masculinised risk profile for things like heart disease. And in many ways any given trans person may be subject to a “mixed sex" pattern of needs and risks in terms of health. Some people have proposed organ inventories as a solution, but even these may create a tendency to obscure the specific needs of trans patients as differentiated from cisgender patients.

Dimorphism is a population level pattern of two rough clusters of biological traits, not an individual reality. This isn’t rocket science.

Sex is real. It’s also complex and we need to put biological reality first and not idealised models of sex masquerading as biological reality.